NRA Law Enforcement Firearm Instructor …

1 NRA Law Enforcement Firearm Instructor development school APPLICATION Tuition is $645 payable to NRA upon application prior to school . Range Fee, if any, is payable on site to the hosting agency, not NRA. Schools are limited in size. Slot confirmation will be provided via email upon receipt and approval of completed Application paperwork and tuition payment in full (or state or local agency ). An incomplete Application will prevent enrollment consideration. Students are responsible for providing their own Firearm (s), ammunition, related equipment, transportation, meals and lodging. Student cancellations made less than 10-days from the first day of school may incur a $100 non-refundable fee.

2 Cancellations made otherwise will receive a full refund. The NRA is not responsible for any expenses incurred by the applicant, other than refund of tuition in the event the school is cancelled. The NRA retains the right to accept or decline applications. Send Application, readable copy of current Law Enforcement or Armed Security photo ID & $645 tuition payment to: NATIONAL RIFLE ASSOCIATION Law Enforcement Division 11250 Waples Mill Road Fairfax, VA 22030 Phone: (703) 267-1640 - Fax: (703) 267-3834 - school DATES: _____ LOCATION: _____ TYPE: _____ APPLICANT S NAME: _____ AGE: _____ AGENCY NAME: _____ E-MAIL: _____ AGENCY STREET ADDRESS: _____ CITY: _____ STATE: _____ ZIP: _____ HOME STREET ADDRESS: _____ CITY: _____ STATE: _____ ZIP: _____ AGENCY PHONE: _____ HOME PHONE: _____ FAX: _____CELL PHONE: _____OTHER E-MAIL:_____ TYPE OF Firearm (S) TO BE USED: _____ CALIBER/GAUGE.

3 _____ Payment (circle one): Check /Money Order Credit Card State or local Purchase Order# :_____ Credit Card #: _____ Type: _____ Expiration Date: _____ Cardholder s Name: _____ Billing Zip Code: _____ Signature for Credit Card Authorization: _____ Date: _____ (You Must Complete Pages 1, 2 & 3) Rev 10/16 APPLICATION ( Check ONE box, fill in corresponding blank(s), and attach required supporting documentation.) I am currently a PUBLIC Law Enforcement or a PRIVATE Security officer: Public law Enforcement or correctional officer, working for a federal, state, county, municipal or other governmental law Enforcement and required to be armed.

4 Number of years of total service: _____ (require minimum of 3) A readable copy of your Law Enforcement photo ID must accompany application. Licensed by a federal, state, county, or municipal licensing board or agency as private security officer or privatized correctional officer who is authorized and required to be armed in my official capacity. Number of years of total service: _____ (require minimum of 3) A readable copy of your Armed Guard photo ID must accompany application. Nuclear Security, Number of years of total service: _____ (require minimum of 3) I AM NOT a PUBLIC Law Enforcement or a PRIVATE Security officer, however I am: A RETIRED public law Enforcement officer, who worked for a federal, state, county, municipal or other governmental law Enforcement agency who was required to be armed.

5 Number of years of total service: _____ (require minimum of 3) A readable copy of your Retired LE photo ID must accompany application. A PREVIOUSLY EMPLOYED public law Enforcement officer who worked for a federal, state, county, municipal or other governmental law Enforcement agency who was required to be armed. Number of years of total service: _____ (require minimum of 3) A readable copy of your Previous LE photo ID or employer verification letter must accompany application. A uniformed or civilian member of the Military, Military Reserves or National Guard. (Regrettably, former and/or retired military are not eligible).

6 A letter on unit or organization letterhead from a Senior NCO or other authorized person, requesting your attendance in this school , and a readable copy of a government issued photo ID must accompany application. Full-time civilian Firearm Instructor employed by a PUBLIC law Enforcement agency A readable copy of your employee photo ID or employer verification letter must accompany application. Government Contractor (GSA Approved) A letter on company letterhead verifying your current employment, and/or GSA contractual agreement, and a readable copy of your government-issued photo ID must accompany application. AFFIRMATION FOR ALL APPLICANTS I AFFIRM THE FOLLOWING: I AM A CITIZEN OF THE UNITED STATES OR A LAWFUL PERMANENT RESIDENT OF THE UNITED STATES; I MAY LAWFULLY POSSESS FIREARMS AND AMMUNITION; I MAY LAWFULLY ATTEND THIS school AND LAWFULLY RECEIVE ASSISTANCE, TRAINING, DATA AND INFORMATION REGARDING LAW Enforcement TECHNIQUES AND EQUIPMENT, INCLUDING FIREARMS AND AMMUNITION; I HAVE READ AND UNDERSTAND THE REQUIREMENTS AND RESTRICTIONS ON ATTENDING THIS TRAINING; AND THE INFORMATION I HAVE PROVIDED IS TRUE AND ACCURATE.

7 _____ _____ _____ PRINTED NAME SIGNATURE DATE Rev 10/16 RELEASE, WAIVER, INDEMNIFICATION, HOLD HARMLESS, AND ASSUMPTION OF THE RISK AGREEMENT WHEREAS, in return for instruction in firearms, use of premises, and for other good and valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Undersigned agrees to the following: The Undersigned shall indemnify, hold harmless and defend the National Rifle Association of America, and any of its employees, directors, officers, contractors, agents and any people or entities similarly situated to any of the foregoing, (hereinafter, collectively "NRA"), from any and all fault, liabilities, costs, fees, expenses, claims, remedies, demands, actions, lawsuits, or any similar matters, arising out of, or related to or connected with: the discharge of firearms; the course of instruction; the Undersigned's participation in the course of instruction.

8 The range, buildings, land and premises used for the course of instruction (hereinafter the "Premises"); the Undersigned's presence on or use of said Premises; and any and all acts or omissions of the Undersigned. And should any such matter arise or be asserted in any way whatsoever related thereto, under any theory of law or equity, the Undersigned will indemnify, hold harmless and defend NRA, from any and all costs, expenses or liability including, but not limited to, the cost of any settlement or judgment made or rendered against NRA, whether individually, jointly, or in solido with the Undersigned, together with all costs of court and other costs or expenses incurred in connection with any such matter, including attorney's fees.

9 The Undersigned furthermore waives for himself/herself and his/her executors, administrators, assignees or heirs, any and all rights and claims for fault, liabilities, costs, fees, expenses, claims, remedies, demands, actions, lawsuits, or any similar matters, which he/she may have or which may arise against the NRA, (including, but not limited to any and all injuries, damages or illnesses suffered by the Undersigned or the Undersigned's property), which may, in any way whatsoever, arise out of, be related to or be connected with: the course of instruction; the Premises, including any latent defect in the Premises; the Undersigned's presence on or use of said Premises; the Undersigned's property (whether or not entrusted to the NRA); or the discharge of firearms.

10 NRA shall not be liable for, and the Undersigned, on behalf of himself/herself and his/her executors, administrators, assignees or heirs, hereby expressly releases NRA from any and all such claims. The Undersigned hereby expressly assumes the risk of entering the Premises and of taking part in activities on the Premises which include, but are not limited to, instruction in the use of firearms, the discharge of firearms and the firing of live ammunition. The Undersigned furthermore hereby acknowledges and agrees that he/she has read, understands and will at all times abide by all NRA range rules and procedures. This instrument binds the Undersigned and his/her executors, administrators, assignees or heirs.